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Recent Breakthroughs in the Treatment of Upper Gastrointestinal Cancers

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Stony Brook’s Chief of Upper Gastrointestinal and General Oncologic Surgery, Kevin Watkins, MD, who performed the world’s first irreversible electroporation (IRE) procedure to treat pancreatic cancer, and Jonathan Buscaglia, MD, Director of the Advanced Endoscopy Center, explain the latest advances in treatments and therapies for these upper GI cancers.

Over the past 10 years, new treatments for upper gastrointestinal (GI) cancers such as liver and pancreatic cancer have resulted in significantly better outcomes and improved survival rates.

What’s new for patients with pancreatic cancer?

For patients whose pancreatic cancer has not metastasized (spread elsewhere in the body), there are several new options that did not exist previously or were unavailable in our region until recently.

Irreversible electroporation (IRE): Previously, local tumor ablation (destruction of the tumor without surgically removing it) in the pancreas was not possible since heat or cold damage had significant detrimental effects. IRE is a surgical technique that kills the cancer by using electrical fields to generate pores in the tumor cells.

The NanoKnife®, a computerized system used for the procedure, uses brief and controlled electrical impulses to open microscopic pores in a targeted area. By increasing the number, strength and duration of the electrical pulses, pores in the cells remain open permanently, causing microscopic damage. The cells then die, and the body rids itself of these dead cells. In December 2009, Kevin Watkins, MD, performed the world’s first IRE for pancreatic cancer.

Robotic pancreaticoduodenectomy: Commonly referred to as the Whipple procedure, this surgery is considered one of the most difficult abdominal surgeries to perform. It requires the use of laparoscopy and robotics and involves the removal of a portion of the stomach, the gallbladder, the head of the pancreas and the duodenum. In 2009, Stony Brook surgeons successfully performed the region’s first robotic Whipple procedure for treating pancreatic cancer.

Are there any new treatments for patients with liver cancer?

Yes, radiofrequency ablation (RFA) is a new minimally invasive treatment that is an alternative when surgery is not a good option for patients. The physician inserts a thin needle, guided by computed tomography (CT) or ultrasound, through the skin and into the tumor. Electrical energy delivered through this needle heats and destroys the tumor.

Have any strides been made in palliative care?

Significant strides have been made in palliative care for patients with pancreatic cancer. There are new bile duct stents designed to prevent tumor ingrowth and further duct blockage by staying open for longer periods of time, thus relieving jaundice and improving symptoms. Also, researchers are examining drug-eluting (coated with medicine) bile duct stents for pancreatic cancer. The use of endoscopic ultrasound (EUS) guided fine-needle injection, radiation beads and chemotherapeutic agents (i.e., Taxol®) are also being examined.

What about the patient who has metastatic liver cancer?

A significant number of patients with colon or rectal cancer will develop spread of the cancer to the liver. Recent advances in liver-guided treatments have provided the opportunity to treat this form of tumor spread.

Chemoembolization: This minimally invasive, image-guided procedure involves administering an anticancer drug in spheres directly into the arteries that supply the tumor. It is designed to cut off the tumor’s blood supply to selectively destroy and kill the malignant cells.

Yttrium-90 therapy: Tiny, resin microspheres (small particles) that emit yttrium-90 are implanted into the liver to deliver radiation directly to the tumor and help slow its progression. For patients who are candidates, yttrium-90 therapy may result in an improvement in quality of life and can extend a patient’s life expectancy.

For more information about upper gastrointestinal cancers, call (631) 444-4000.

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